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I <br />14I LIABILITY I <br />DATE n'Yrr) <br />8/277/20/2013 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES. <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />George Petersen Insurance Agency, Inc. <br />P.O. Box 3539 <br />Santa Rosa, CA 95402 <br />CONTACT <br />NAME: <br />PHONE FAX (7 ) <br />Ext : ($00 236-9046 4178 Arc No : 07 525-41 T5 <br />EAiNi <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE MAIC 0 <br />INSURER A: Westchester Surplus Lines Insurance Co. <br />10/11/2012 <br />INSURED <br />INSURERS: WaUS8u Underwriters Insurance <br />Able Maintenance Inc. <br />INSURER C: American Fire & Casualty <br />INSURER D: State Compensation Ins. Fund <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />INSURER E: <br />INSURER F: <br />PRODUCTS - COMP/OP AGG $ 51000,000 <br />L:UVtKAULb CERTIFICATE NUMBER: REVISION NUMBER: 1 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />TR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFF <br />(MMIDDD= <br />POLICY EXP <br />JKK2R0=LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR <br />X Pollution & Profess. <br />622070800008 <br />10/11/2012 <br />10/11/2013 <br />EACH OCCURRENCE $ 5,000,00( <br />DAMAGE ESTO a RENTED $ 50.000 <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL & ADV INJURY $ 51000,000 <br />GENERAL AGGREGATE $ 5,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY JECIPRO LOC <br />PRODUCTS - COMP/OP AGG $ 51000,000 <br />MOLD $ 11000,000 <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />ASJZ91459057013 <br />4/1/2013 <br />4/1/2014 <br />COMBINED SIN LE LIMIT <br />Ea accident 1,000,000 <br />BODILY INJURY (Per person) $ <br />BODILY INJURY Per accident $ <br />( ) <br />PROPERTY DAMAGE <br />Per accident $ <br />C <br />X <br />UMBRELLA UAB X <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />JEUA1455094511 <br />4/1/2013 <br />4/1/2014 <br />EACH OCCURRENCE $ 4,000,00 <br />AGGREGATE $ 4,000,00 <br />DED I I RETENTION <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />K yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />9073219-13 <br />10/1/2013 <br />10/1/2014 <br />WC STATU- OTH- <br />X TORY IM ER <br />E.L. EACH ACCIDENT $ 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />Evidence of coverage <br />Evidence Of Coverage <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />31. <br />W 18tW-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />